NPR segment on DNP's - make your voices heard!

[mdx2x]

Ignoring herbal drugs used by patients can lead to very bad consequences. Sad, but it happens a lot. Hmm you can also pimp m3/m4's with it.

In these day and age where everyone relies pretty much on technology and its pace, patient most of the time wants a doctor who will take time, listen, and touch them... using clinical examination techniques *gasp!* Instead of just relying test after test.

Great diagnostician are great doctors, yet it's now a lost art.

Btw... I think wrongdiagnosis.com is more helpful... ironically it uses a lot nursing reference

---

Members don't see this ad.

 

[EternalMD]

I don't know any DNPs. Just wondering where do you go when all the specialists throw up their hands. That's what I'm asking. What's your answer?

I still don't understand why you think that nurses can help in this situation. Please enlighten us as to what you would do with these "failures"? Don't dodge the question - Answer it - WHAT CAN A NURSE DO HERE? You want those people to go see a nurse who is going to do what exactly? Aside from wiping my arse and jotting down made up vital signs, I don't see what help that would be

 

[silas2642]

I don't know any DNPs. Just wondering where do you go when all the specialists throw up their hands. That's what I'm asking. What's your answer?

I would say that true medical mysteries are very rare. Most pt illnesses have an answer to them and that answer lies in science-- someone can diagnose your pt and offer them an answer, peace of mind, and hopefully treatment, even though it may not be you or your colleagues in your area. A sign of a good physician is knowing when to refer and who to refer to. If the case is ultra-difficult, perhaps that physician should consider rerferring to a clinic that specializes in disorders of that type, perhaps Mayo, MGH, BWH, Columbia, etc. But you don't send a patient who you have no idea what's going on with to someone with less experience and less education-- that doesn't make any sense. You move up the line in education and expertise, not down.

 

[asunshine]

Aside from wiping my arse and jotting down made up vital signs, I don't see what help that would be

You really feel that way about nurses?

 

[EternalMD]

You really feel that way about nurses?

no because aside from one, most have been pretty nice and helpful - This guy however seems to think that there is something else that he can contribute to the "medical failures".

 

[Taurus]

Who here still thinks that DNP's will be content with just primary care? GI, cards, derm are in their cross-hairs.

Claudia Christensen, FNP, CGRN, nurse endoscopist and colorectal screening coordinator in the surgery services department of the Alaska Native Medical Center, has in fact performed more than 1,200 screening colonoscopies over the past three years; prior to which she (also for three years) performed flexible sigmoidoscopies.

There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant.​

 

[scube]

WOW. maybe someone will let their NP do a few neurosurgeries as well. I can see it now.

Person:Hi nice to meet you, what do you do?
DNP: Im A neurosurgeon
Person: Really. where did you go to medical school
DNP: ONLINE

a line, draw a line.

 

[scube]

according to the online link of taurus sig. there is an online program. 225 dollars an hour. 37 hours. I hope thats a semester and for four years.

"I am currently enrolled in the University of South Alabama, in the FNP Master's program. They also have an online DNP, which I am considering when I am done. Tuition is $227/hr. It is a 37 hour program. Their website is http://southalabama.edu/nursing/DNP.html"

 

[benjee]

Who here still thinks that DNP's will be content with just primary care? GI, cards, derm are in their cross-hairs.

Claudia Christensen, FNP, CGRN, nurse endoscopist and colorectal screening coordinator in the surgery services department of the Alaska Native Medical Center, has in fact performed more than 1,200 screening colonoscopies over the past three years; prior to which she (also for three years) performed flexible sigmoidoscopies.

There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant.​

The problem is those DNP or Nps or PAs thought once they do lots of procedures eg. colonoscopy..etc they can pretend as Mds to practice medicine independently. They have no foundation in solid medical knowledge whatsoever to make any diagnosis,treatment..etc. All they can work is as a technician who did lots of procedures without knowing anything about disease processes , consequences or complications.

 

[ZincFingers]

Incidentally, could someone explain to me why NPs are regulated by boards of nursing and not medicine? Wherever a practitioner comes from - med school, NP school, school of hard knocks - if they're treating patients and writing scrips independently, there should be ONE board that watches them. Rename it into the "board of medicine and nursing" or "board of healing arts," I don't care.

 

[benjee]

Incidentally, could someone explain to me why NPs are regulated by boards of nursing and not medicine? Wherever a practitioner comes from - med school, NP school, school of hard knocks - if they're treating patients and writing scrips independently, there should be ONE board that watches them. Rename it into the "board of medicine and nursing" or "board of healing arts," I don't care.

It may be due to NP is created by board of nursing instead of medicine board since no medical board will approve this kind of quasi doc. to endanger the public health. But if NPs are allowed to practice medicine independently pretending docs, i would encourage the public to file lawsuits against any of these NPs since this is a crime to put public health in danger.

 

[mig26x]

Its funny how my institution is asking its residents that want to moonlight to have step 3 and one year of residency completed and that there will be always an attending to precept with BUT this NP's can run minute clinics by themselves w/o direct supervision.

And I thought I was the one that went to med school.

Something is pretty F$ck up here!!!

 

[zenman]

I still don't understand why you think that nurses can help in this situation. Please enlighten us as to what you would do with these "failures"? Don't dodge the question - Answer it - WHAT CAN A NURSE DO HERE? You want those people to go see a nurse who is going to do what exactly? Aside from wiping my arse and jotting down made up vital signs, I don't see what help that would be

I'm certainly won't dodge any question about what I do. But first, you (and maceo) tell me what you do when you have a patient who you have to tell there is nothing else you can offer.

 

[zenman]

I would say that true medical mysteries are very rare. Most pt illnesses have an answer to them and that answer lies in science-- someone can diagnose your pt and offer them an answer, peace of mind, and hopefully treatment, even though it may not be you or your colleagues in your area. A sign of a good physician is knowing when to refer and who to refer to. If the case is ultra-difficult, perhaps that physician should consider rerferring to a clinic that specializes in disorders of that type, perhaps Mayo, MGH, BWH, Columbia, etc. But you don't send a patient who you have no idea what's going on with to someone with less experience and less education-- that doesn't make any sense. You move up the line in education and expertise, not down.[/QUOTE


Yes, but your thought process is limited by your educational background.

 

[mdx2x]

Claudia Christensen, FNP, CGRN, nurse endoscopist and colorectal screening coordinator in the surgery services department of the Alaska Native Medical Center, has in fact performed more than 1,200 screening colonoscopies over the past three years; prior to which she (also for three years) performed flexible sigmoidoscopies.

There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant.​

Scary! There must be doctors who trained them at first. Nevertheless it's still a scary thought

 

[benjee]

Yes, but your thought process is limited by your educational background.[/QUOTE]

yes, that's why "medical failure" should go to witches, psychics, or may be fortune teller, but definitely not DNP.
It is not helpful only to argue or discuss in this forum , the only way to tell is seeking treatment from DNPs ONLY when YOU are severly sick . Don't even bother to see a MD.

 

[EternalMD]

I'm certainly won't dodge any question about what I do. But first, you (and maceo) tell me what you do when you have a patient who you have to tell there is nothing else you can offer.

While you stated you wouldn't dodge the question, you did exactly that. Much like DNPs trying to say they're not trying to be doctors, but trying to do exactly that.

First off, I have seen a few patients in which we have tried to uncover the source of their problem only to have to discharge the patient without knowing what it was. Even though the patient was gone, I kept trying to find literature articles that would offer some solution to the problem at hand (the attending also would present some articles but then explain why they wouldn't work in our patient). In the end, I found one obscure article that recommended a treatment plan which was effective in 6 out of the 19 patients they worked on (small sample size, different patient population, etc etc... lots of confounding variables making it a weak study to go on). So you then have to ask yourself this: is it worth it to bring the patient back to run more tests in order to try this treatment with all the financial burden it will place on him? It was a judgment call that I ultimately let the attending come to since I moved onto a different specialty rotation. But you see, when patients leave the hospital, especially at academic institutions, the physicians will continuously search for a solution. Some may eventually give up but the piont is that there is still some effort being made. THAT is the best I could offer a patient - the promise to keep trying to find a cause/treatment for their condition

Now tell me what YOU would do and please, don't dodge the question once again.

 

[mig26x]

I would say that true medical mysteries are very rare. Most pt illnesses have an answer to them and that answer lies in science-- someone can diagnose your pt and offer them an answer, peace of mind, and hopefully treatment, even though it may not be you or your colleagues in your area. A sign of a good physician is knowing when to refer and who to refer to. If the case is ultra-difficult, perhaps that physician should consider rerferring to a clinic that specializes in disorders of that type, perhaps Mayo, MGH, BWH, Columbia, etc. But you don't send a patient who you have no idea what's going on with to someone with less experience and less education-- that doesn't make any sense. You move up the line in education and expertise, not down.[/QUOTE


Yes, but your thought process is limited by your educational background.

which is 100 times more that of a NP or DNP. so again by referring the case to a NP or DNP they would be going down the thought process.

 

[deleted89854]

Scary! There must be doctors who trained them at first. Nevertheless it's still a scary thought

Depends on how they measured "outcome". Colonoscopy is a low-morbidity procedure, so I would not expect any difference at all at one day, week, or year (unless the RNPs are just perfing people all over the place). No one is likely to die from their missed polyp (which would have been picked up by a more experienced and knowledgable provider) during a period of one year. Therefore the study is worthless, useless, and dangerous.

Maybe I'm wrong, and outcomes would be equivalent. However, this study does not prove anything except that RNPs have superior customer satisfaction ratings. Although physicians definitely need to work toward increasing customer satisfaction. I think what a lot of the residents don't see is that a lot of the business of medicine is about marketing yourself (I think I recall winged scapula menitioning somethign about personalized M&Ms).

 

[zenman]

Some may eventually give up but the piont is that there is still some effort being made. THAT is the best I could offer a patient - the promise to keep trying to find a cause/treatment for their condition

Now tell me what YOU would do and please, don't dodge the question once again.

Good. I'm also a shaman so all I'm asking is to consider things outside your realm, as many of my fellow shamans who are nurses, physicians, and mental health professionals do.

PS: I'll always put up.

 

[niranjan162]

I'm certainly won't dodge any question about what I do. But first, you (and maceo) tell me what you do when you have a patient who you have to tell there is nothing else you can offer.

Good. I'm also a shaman so all I'm asking is to consider things outside your realm, as many of my fellow shamans who are nurses, physicians, and mental health professionals do.

PS: I'll always put up.

hmmmm...good answer

 

[EternalMD]

Good. I'm also a shaman so all I'm asking is to consider things outside your realm, as many of my fellow shamans who are nurses, physicians, and mental health professionals do.

PS: I'll always put up.

way to put up

 

[njac]

Psychopharmacology
Primary Meds Pharmacology

Herbal Pharmacology

My mom is a RN. Did cardiac ICU for about 20 years and then various other things. She's now doing cardiothoracic quality at a hospital for one of the Ivy League Med School hospitals.

I tend to be pretty pro-nursing, but where do you see the role for the pharmacist here. The American College of Clinical Pharmacy has a psychiatric pharmacy board certification. We have classes in herbals. Primary maintenance medication is a huge part of our training as well. So are nurses wanting to be physicians and clinical pharmacists now too?

 

[scube]

My mom is a RN. Did cardiac ICU for about 20 years and then various other things. She's now doing cardiothoracic quality at a hospital for one of the Ivy League Med School hospitals.

I tend to be pretty pro-nursing, but where do you see the role for the pharmacist here. The American College of Clinical Pharmacy has a psychiatric pharmacy board certification. We have classes in herbals. Primary maintenance medication is a huge part of our training as well. So are nurses wanting to be physicians and clinical pharmacists now too?

now you've done it... went and gave them a good idea.

 

[zenman]

My mom is a RN. Did cardiac ICU for about 20 years and then various other things. She's now doing cardiothoracic quality at a hospital for one of the Ivy League Med School hospitals.

I tend to be pretty pro-nursing, but where do you see the role for the pharmacist here. The American College of Clinical Pharmacy has a psychiatric pharmacy board certification. We have classes in herbals. Primary maintenance medication is a huge part of our training as well. So are nurses wanting to be physicians and clinical pharmacists now too?

Nurses, NP, PA, Physicians see patients. Many patients take herbs. Everyone taking care of patients should have a knowledge of herbs, and also that many people are afraid to tell their physician they are using them. Pharmacists can do as they wish. I'm talking about the first line provider...the person who writes the script.

 

[Taurus]

So are nurses wanting to be physicians and clinical pharmacists now too?

I think that nursing claims that accounting, legal services, and engineering are also part of nursing because they "see the whole picture" and not just the numbers.

 

[EternalMD]

Nurses, NP, PA, Physicians see patients. Many patients take herbs. Everyone taking care of patients should have a knowledge of herbs, and also that many people are afraid to tell their physician they are using them. Pharmacists can do as they wish. I'm talking about the first line provider...the person who writes the script.

So at least we have uncovered what you have to offer to patients who are "medical failures" : Herbs.

 

[zenman]

I think that nursing claims that accounting, legal services, and engineering are also part of nursing because they "see the whole picture" and not just the numbers.

FYI, back in the days when I started nursing was responsible for a lot, including nutrition, PT, OT, RT, etc. I still remember those green IPPB BIRD machines and giving treatments, diathermy, elect stim, etc. Nurses are basically generalists and like FP docs, supposed to know a little about everything...or at least used to.

 

[zenman]

So at least we have uncovered what you have to offer to patients who are "medical failures" : Herbs.

Negative my fine fellow but might I recommend a little Ayahuasca?

 

[MDman87]

Ive never heard the term medical failure ever. is that a term coined in nursing school? to define nursing students?

This thread is a great read

 

[scube]

FYI, back in the days when I started nursing was responsible for a lot, including nutrition, PT, OT, RT, etc. I still remember those green IPPB BIRD machines and giving treatments, diathermy, elect stim, etc. Nurses are basically generalists and like FP docs, supposed to know a little about everything...or at least used to.

none of those things are diagnosing and differentiating disease, formulating a treatment plan or doing a surgical procedure. all of the things you mention are being done by a field now.

 

[zenman]

uh, wasn't that my point?

 

[scube]

uh, wasn't that my point?

Uhh it has been your point in nearly every other post you have made and is in fact the theme of the thread.

 

[zenman]

I think that nursing claims that accounting, legal services, and engineering are also part of nursing because they "see the whole picture" and not just the numbers.

Let me do it again. Nurses, in their basic training are generalists, less so now than before but still trained to know a little about a lot (kinda like primary care). Certainly other fields have cropped up to specialize. So, yes, nurses should "see the whole picture." Should be quite simple to understand even through reductionist lens.

 

[twmc3]

Ok, I've read through most of this thread and I really think there some some serious misconceptions about what the goal of a DNP are. I am currently a RN with a bachelor's in both nursing and chemistry. I have yet to decide what route to go, practicality probably will force me to consider advanced practice as a nurse rather than going to medical school. That decision is almost entirely due to life situation and no other reason.

1) No NP/DNP I have met wants to be called "Dr. Anyone". Why? That's an honorary title for those who did MD/DO or for PhD's in an academic enviroment. Honestly, most nurses that pursue higher degrees just simply don't want to have to wipe another ass. (Which I think is a very WRONG attititude, but it's more true than you might expect.)

2) State boards of nursing have a tight leash on what a NP can or can not do. In broad terms we're not allowed to do anything that even looks like a specialty unless we work for a physician. In states we can operate individually they are restricted to being mid level providers and must refer out anything that is beyond that fairly narrow scope.

3) If you seriously think all MDs are great, or all NPs are lousy, you are already very very wrong. There is MDs that I will avoid like the plague if they are on call (I'm a night Neuroscience ICU RN at the moment). Likewise there are RNs, DNPs, RTs that each fall into the same category.

4) Your math on years of education is off generally speaking. A DNP is required to have a BSN (4 years), DNP school (another 4 years) and almost every program I've seen requires 1 year on the job as an RN, prefer 2 (and yes I disagree with those that are will to "fast track BSNs" to DNP. Part of the point of our not needing a residency is that we worked in the real world for at least a bit. By my count BS is 4 years, 4 years med, 3 years residency makes the total 11 vs 9. Considering compensation and scope differences, I'm a bit disappointed in some medical specialties getting off so light.

Now there is some EXTREMELY valid points about nursing, some of them that frustrate me to no end.

1) The notion that nursing can divorce itself from medicine is ridiculous. Nurses try that nonsense with me and they get an earfull. Nursing and medicine are reliant on each other and if you don't think that is the case you are also very very wrong. People go to hospitals for nursing. You can get medical care as an outpatient. (Think VERY carefully about that concept.)

2) Nursing needs to get it together when it comes to national standards. I realize there a popular opinion that the USMLE is some magical standard. It's a test like all others and therefore can be taught and studied for. I have found tests do little aside from give everyone some notion of bare minimum competence. Nursing definitely needs to firm up it's base knowlege/testing. Keep in mind medicine is years ahead as a profession in this matter. Nursing will have to mature also.

3) General knowledge of pathophysiology really needs to be better at all levels of nursing. Period.

4) I absolutely agree if a NP wants to get paid or respected, they also need to accept legal liability.

5) The continued acceptance of associate level degrees as the entry degree to nursing is absolutely abhorrent. There needs to be MUCH more science and math in the basic entry level nursing degree which should be a bachelor's. I could not believe that they only needed college algebra and minimal chem/bio to get in. In my first school EVERYONE had to take what amounted to pre-med requirements no matter what the degree was (Calc I/II, Chem I/II, Bio or Geo I/II, Physics I/II, so on).

The reality of the problems in healthcare mean that there is a huge need to fill. Unfortunately there has been bad planning and poor recognition of need in this country. Otherwise there wouldn't have been a demand for NPs or PAs and yet there is a huge demand for them. There is nothing any group of people can do about this aside from having an explosion of seats in medical schools, which you and me both know that will not happen.

And if you wanted to get rich, boy did you pick the wrong career field. Nobody gets "rich" in this business. You just get less poor.

I would love to discuss what I think the healthcare structure will look like in the US in future, but seems terribly off topic. I will say that I think what a DNP SHOULD be is either a general practitioner prehospital or in the acute care setting a "clinical lead that has the authority to prescribe and care for immediate needs along the lines of a general critical care practitioner" (aka don't bother calling the MD unless it's something well beyond a generalists ability, or would you SERIOUSLY want me to wake you up for Guaifenesin)

Best of luck, and quit stressing about what other people are doing. You'll always have a job, even if you suck at it.

 

[silas2642]

Let me do it again. Nurses, in their basic training are generalists, less so now than before but still trained to know a little about a lot (kinda like primary care). Certainly other fields have cropped up to specialize. So, yes, nurses should "see the whole picture." Should be quite simple to understand even through reductionist lens.

It was my understanding that physicians are trained to see the big picture and the details (after all, God IS in the details sometimes). Sort of makes them more qualified to diagnose and treat the patient, so stop being so condescending please.

 

[zenman]

It was my understanding that physicians are trained to see the big picture and the details (after all, God IS in the details sometimes). Sort of makes them more qualified to diagnose and treat the patient, so stop being so condescending please.

Don't mean to be condescending; just responding to Taurus

I think that nursing claims that accounting, legal services, and engineering are also part of nursing because they "see the whole picture" and not just the numbers.

Actually you can also add "Environmental Engineer" as I've never seen housekeeping clean up anything other than a water spill. Point I'm making is that nurses are jack of all trades in actually "doing", not just "seeing." Whether that is good or bad, I don't care anymore. Having to do "everything" is one reason you won't find my butt at the bedside anymore.

 

[Hayduke]

Thank you for piping in on this thread. It is nice to hear from a nurse that obviously has done some thinking about the issues swirling here now on page #4.
Now allow me to correct some of your errors/misperceptions.

I have yet to decide what route to go, practicality probably will force me to consider advanced practice as a nurse rather than going to medical school. That decision is almost entirely due to life situation and no other reason.:

When I ask RNs why they are going to NP school, I get one of two answers. A minority will give me some crock of "superior caring, empathetic model" crap. The vast majority, and this sounds like you, will tell me honestly that the sacrifices demanded by medicine are too great. We all have 'life situations'. If you want to be the chief clinician for a patient/unit, go to real doctor school. Better still, stay a bedside nurse, we need you more.

1) No NP/DNP I have met wants to be called "Dr. Anyone". Why? That's an honorary title for those who did MD/DO or for PhD's in an academic enviroment.

This is very different from the pre-NP folks I am talking to right now. I had a conversation with a BSN yesterday morning. She is bright and has a WHOLE year of bedside care under belt. She was beaming about her acceptance to the NP program at our university. "I'm going to be a doctor! Everyone in my class will be." She will achieve this title in just over six semesters during which time she may have to drop her work hours down to 30 per week.
NP schools are driving this degree. The training, while completely insufficient, holds the doctorate title up as golden ticket. You pay a lot of money, put up with the sadism of nursing education, and then get thrown into the workplace. Being a "doctor" is the one tangible you have achieved.

2) State boards of nursing have a tight leash on what a NP can or can not do. In broad terms we're not allowed to do anything that even looks like a specialty unless we work for a physician. In states we can operate individually they are restricted to being mid level providers and must refer out anything that is beyond that fairly narrow scope.:

Defining the narrow scope is impossible.

4) Your math on years of education is off generally speaking. A DNP is required to have a BSN (4 years), DNP school (another 4 years) and almost every program I've seen requires 1 year on the job as an RN, prefer 2 (and yes I disagree with those that are will to "fast track BSNs" to DNP. Part of the point of our not needing a residency is that we worked in the real world for at least a bit. By my count BS is 4 years, 4 years med, 3 years residency makes the total 11 vs 9. Considering compensation and scope differences, I'm a bit disappointed in some medical specialties getting off so light.:

This is the offensive bit. I hear it from DNPs-to-be all the time. The BS has two years of actual nursing. This is a vocational degree. Most nurses I know, including myself, work at least part time through their bachelors.
The majority of NP programs are now fast tracks. 50% of the current BSN class at my place is slated for the NP program.
The intensity and time requirement of medical school is something that no nurse can understand. They really believe that the graduate clsses they are taking compare to the coursework and testing involved in MS1 and 2. The clinical hours of yera 3 and part of year 4 is another universe from the NP "hour requirement". I had more training time in my med student 3rd year surgery and OB rotations than the DNP gets her entire educational career. Holding any job during that time is difficult, and for most people totally impossible. Every NP student I know works at least part time. The year for year comparison just does not hold.

The best analogy for medical school after being nurse is Neo in the Matrix taking the red pill. My universe underwent a radical shift. I had no idea what would be asked of me. Most nurse just don't get it.

And about the year of work thing...I worked as an RN for 5 years before medicine. I knew my way around a hospital and equipment, could change a bed with someone in it, and became a good phlebotomist. Beyond these skills and a decent work ethic, my time nursing did very little to enhance my medical practice.

1) The notion that nursing can divorce itself from medicine is ridiculous. Nurses try that nonsense with me and they get an earfull. Nursing and medicine are reliant on each other and if you don't think that is the case you are also very very wrong. People go to hospitals for nursing. You can get medical care as an outpatient. (Think VERY carefully about that concept.):

No. Actually people go to hospitals to get well. They are seeking expertise and assistance about something they usually know very little, their health. The expert they are seeking is a physician. The treatment and caring directed/ordered by the physician is carried out by skilled, empathetic and well compensated technicians that hold the title of nurse. The physician cannot do everything that is needed for the care he directs. He needs nurses to complete his plan and deliver care to the person seeking his help.

2) Nursing needs to get it together when it comes to national standards. I realize there a popular opinion that the USMLE is some magical standard. It's a test like all others and therefore can be taught and studied for. I have found tests do little aside from give everyone some notion of bare minimum competence.

Truth

3) General knowledge of pathophysiology really needs to be better at all levels of nursing. Period.:

Why?

5) The continued acceptance of associate level degrees as the entry degree to nursing is absolutely abhorrent. There needs to be MUCH more science and math in the basic entry level nursing degree which should be a bachelor's. I could not believe that they only needed college algebra and minimal chem/bio to get in. In my first school EVERYONE had to take what amounted to pre-med requirements no matter what the degree was (Calc I/II, Chem I/II, Bio or Geo I/II, Physics I/II, so on).:

I completely disagree. We need a return to the diploma degree and need to fast track every allied health worker available to be NCLEX eligible. We do not need mini doctors at the bedside making gueses at disease and treatment options. We need technicians in there passing meds correctly, wiping those butts and monitoring v/s and tele. Nursing has abandoned patient care in its efforts to reach physician equivalency. A deep understanding of physiology is not requisite to giving great bedside care.

The reality of the problems in healthcare mean that there is a huge need to fill. Unfortunately there has been bad planning and poor recognition of need in this country. Otherwise there wouldn't have been a demand for NPs or PAs and yet there is a huge demand for them. There is nothing any group of people can do about this aside from having an explosion of seats in medical schools, which you and me both know that will not happen.:

LCME schools have increased enrollment by 15% and DO schools have expanded by almost 30%. We are experiencing a deluge of newly minted doctors. We have specialty congestion in certain geographies. We do not need more clinicans. We need a re-distribution of healthcare. Of course this means actually having to move where you are needed.
Of course these same people that won't sacrifice time and energy for medical school will likely not be looking to assist the people who need them out in BFE.

 

[zenman]

When I ask RNs why they are going to NP school, I get one of two answers. A minority will give me some crock of "superior caring, empathetic model" crap. The vast majority, and this sounds like you, will tell me honestly that the sacrifices demanded by medicine are too great. We all have 'life situations'. If you want to be the chief clinician for a patient/unit, go to real doctor school. Better still, stay a bedside nurse, we need you more.

Here's a third one. Because I want to combine psych with my shamanism practice and to have a greater knowledge of western psych. If I had ever wanted to be a doctor, I would have. But no thanks. I was smart enough many years ago to see that I did not want to waste that much time only to be told by an insurance company high school grad how to practice. I can remember when doctors told me it was actually fun to practice. Good luck on your informed decision. Another reason is that I did not want to get PTSD working at the bedside, caught between patients, families, doctors and admin.

The intensity and time requirement of medical school is something that no nurse can understand. The best analogy for medical school after being nurse is Neo in the Matrix taking the red pill. My universe underwent a radical shift. I had no idea what would be asked of me. Most nurse just don't get it.

If you had no idea what was going to be asked of you, you certainly didn't plan very well did you, lol! Since I'm not a technician I can understand medical school even though I haven't been there. I've certainly been around many who have. Most agree it nothing more than memorizing a pile of facts in the fastest time possible in a survival mode with a tired brain. I'm sure you're smart enough to realize that is one of the worst ways to learn and you're probably lucky to remember half of all that material you paid a high price for. Much of what you learn is based on EBM and I won't even go down that winding path other than to post: http://medicine.plosjournals.org/pe...ocument&doi=10.1371/journal.pmed.0020124&ct=1

... my time nursing did very little to enhance my medical practice.

It's not designed to.

I completely disagree. We need a return to the diploma degree and need to fast track every allied health worker available to be NCLEX eligible. We do not need mini doctors at the bedside making gueses at disease and treatment options. We need technicians in there passing meds correctly, wiping those butts and monitoring v/s and tele. Nursing has abandoned patient care in its efforts to reach physician equivalency. A deep understanding of physiology is not requisite to giving great bedside care.

No, nurses need a BS like any other profession and that degree only needs to be the basic degree, not diploma or ADN. The bedside nurse needs a very good understanding of what's happening with the patient since they are the only ones at the bedside around the clock. If I had been lacking in knowledge there would have been many more dead patients in my long career. Lucky for me all physicians have written orders covering my butt because they knew I just covered theirs.

You're welcome to call nurses technicians, but I say you're also one.

 

[scube]

If you had no idea what was going to be asked of you, you certainly didn't plan very well did you, lol! Since I'm not a technician I can understand medical school even though I haven't been there. I've certainly been around many who have. Most agree it nothing more than memorizing a pile of facts in the fastest time possible in a survival mode with a tired brain. I'm sure you're smart enough to realize that is one of the worst ways to learn and you're probably lucky to remember half of all that material you paid a high price for.Much of what you learn is based on EBM and I won't even go down that winding path other than to post: http://medicine.plosjournals.org/per...d.0020124&ct=1

First, it is nearly impossible to understand what will be asked of you in med school. anyone who says they knew what was coming is very rare, less than 2 %

If those students chose to memorize a pile of facts instead of learning and conceptulizing the human body and medicine then, THEY chose to do it that way. If you learn the concept the details follow.

i looked at that abstract and most of it doesn't apply to medicine. (poor selection criteria, small field, small sample size) which is all true if you know anything about stats. but medicine does what it can to eliminate this, not that it doesn't happen but that scant abstract doesn't apply.

 

[silas2642]

Here's a third one. Because I want to combine psych with my shamanism practice and to have a greater knowledge of western psych. If I had ever wanted to be a doctor, I would have. But no thanks. I was smart enough many years ago to see that I did not want to waste that much time only to be told by an insurance company high school grad how to practice. I can remember when doctors told me it was actually fun to practice. Good luck on your informed decision. Another reason is that I did not want to get PTSD working at the bedside, caught between patients, families, doctors and admin.

If you had no idea what was going to be asked of you, you certainly didn't plan very well did you, lol! Since I'm not a technician I can understand medical school even though I haven't been there. I've certainly been around many who have. Most agree it nothing more than memorizing a pile of facts in the fastest time possible in a survival mode with a tired brain. I'm sure you're smart enough to realize that is one of the worst ways to learn and you're probably lucky to remember half of all that material you paid a high price for. Much of what you learn is based on EBM and I won't even go down that winding path other than to post: http://medicine.plosjournals.org/pe...ocument&doi=10.1371/journal.pmed.0020124&ct=1

It's not designed to.

No, nurses need a BS like any other profession and that degree only needs to be the basic degree, not diploma or ADN. The bedside nurse needs a very good understanding of what's happening with the patient since they are the only ones at the bedside around the clock. If I had been lacking in knowledge there would have been many more dead patients in my long career. Lucky for me all physicians have written orders covering my butt because they knew I just covered theirs.

You're welcome to call nurses technicians, but I say you're also one.

I don't think that you're really qualified to say what med school is like until you've actually sat your butt down and studied the amount of pre-clinical material for 2 years straight, taken step I, then hit the wards for another 2 years. It doesn't matter how many med students you see or how many physicians you talk to, you have no idea what med school or residency is like until you've actually been there.

If all you do is memorize a bunch of random facts without the foundation of concepts, you're dead. Facts go away and can be quickly re-learned by looking them them up on uptodate or on a pda, concepts stay with you, pathophysiology, the WHY, stays with you. That's the difference between doctors and nurses. Nurses are great at pattern recognition (pt. has sxs of x, so it is probably y, we should do z). Ask them why the patient is showing the sxs of x, and what z does to alleviate their sxs, and you'll get a blank expression on their face.

I still meet physicians who think it's fun to practice-- sure medicine has changed a lot in the past few decades, a lot of it for the worse. But the patients are still there and there's a lot more that we can do for them, a lot more of a difference we can make. Think back 50 years ago when a patient presented with depression-- there were so few treatements. What? TCA's, shock treatment? Now look what is in our arsenault.

As for the study that you quoted, you're right. No study is perfect. That's why we're trained to look at studies carefully. We don't look at crap studies (like nursing studies that say that NP's provide care that is superior or equal to that of physicians) and automatically draw a conclusion from that. We take everything into consideration-- the power of the study, the number needed to treat, the effect of the drugs, who funded the sizes, possible biases, etc. You talk about this paper as if physicians weren't aware that many studies are crap-- physicians are completely aware of this.

 

[deleted50478]

I mean, let's get real. We aren't going to dictate who can get a doctoral level degree just because we are doctors of medicine. We're just not.

And as far as the AMA being able to sue to stop the NP doctorate from happening, exactly how would that work? I think the probability of success in such a lawsuit would be close to zero, and it would be a total PR nightmare (evil physicians trying to oppress the nice kind nurses, etc.).

I think the problem isn't so much that nurses would have a doctoral degree pathway, but that the Board of Nursing (or whoever governs these programs) appears to have no standards whatsoever about what minimum level of training is required to qualify it's students as doctoral candidates. There should be some minumum requirements for a doctoral degree, otherwise is devalues the whole thing. Plus, they don't really want to become doctors of nursing, they want to be doctors of medicine and just call it doctor of nursing to avoid all the hastle (med school acceptance, attendance, residency, etc.)

The other problem is that these people clearly move into the practice of medicine but continue to be regulated by the board of nursing which has no interest in appropriately limiting scope of practice. If 'Dr. Nurses' intend to practice medicine, and they do!, they should be regulated by the board of medicine.

Also, the arguments about equivalent training based on years of training overall are absolutely absurd. The time commitment, difficulty, and apptitude required to complete a year of training in different areas is totally different. A year of nursing school and a year of med school are in no way equivalent, they're apples and oranges.

 

[southerndoc]

A little late to the game... but I find it ironic how they mention the physician shortage, but mention nothing of the nursing shortage. Of course the nursing shortage is only going to be made worse as nurses get doctorates and transition into practicing medicine.

I would not have any reservations about the programs if they were actually legit. The thought of one obtaining a DNP through online education is appalling. Nurses think we are targeting them as a profession, when in fact, most of us are displeased with the method they are using to obtain their doctorate. I would take offense and cause the same commotion if a medical school started offering online degrees. There was one medical school in California that promised medical degrees without traditional schooling, and you see the backlash it generated.

 

[scube]

As for the study that you quoted, you're right. No study is perfect. That's why we're trained to look at studies carefully. We don't look at crap studies (like nursing studies that say that NP's provide care that is superior or equal to that of physicians) and automatically draw a conclusion from that. We take everything into consideration-- the power of the study, the number needed to treat, the effect of the drugs, who funded the sizes, possible biases, etc. You talk about this paper as if physicians weren't aware that many studies are crap-- physicians are completely aware of this.

most of the points in that study don't apply to medical studies because we strive very hard to good research, have large sample sizes, and are a large field. also if we assume that that study is correct, then according to the study it is most likely false.

 

[45408]

I can understand medical school even though I haven't been there.

So, even though I've never played in the NFL, I consider myself qualified to comment on what it's like.


You're not in a position to tell us what the learning style in medical school is or isn't like.

 

[benjee]

I have a unique perspective on this. I am a physician (i.e. I actually went to medical school). I was also a nurse and took NP classes.

There is absolutely NO comparison between the two. ZERO. Most NP programs contain less actual "medical" classes than you get in one semester of real medical school. Mine was 15 credit hours. The rest is nursing theory, research, nurse political activism and such. It is so unbelievably different, you can't compare the two. The truly scary thing is that they don't how much they don't know.

NPs, DNPs have absolutely NO right to independent practice. I think there is a role for them such as running coumadin clinics, helping with post-op evals, vaccinations and other such limited practice.

They simply do not have a fraction of the knowledge that the worst FM physician has. Not even close.

Imagine this. Would you let a fourth year medical student open up a clinic and do primary care? H@(( no! And the fourth year medical student already has VAST more medical education than an NP or DNP.

If this does not bother you, it should. I've seen the inside politics of this debate. These people want your job. They hate, resent and envy you. They are cunning and very political active. If we don't stop them, it will negatively affect us all. And their pathway to "independence" will be littered with the dead bodies from their blissful ignorance and pride.

well said. And strongly suggest to let Pioneer of DNP Ms. Mary Mundinger know.

 

[zenman]

So, even though I've never played in the NFL, I consider myself qualified to comment on what it's like.


You're not in a position to tell us what the learning style in medical school is or isn't like.

Thanks. Maybe that's why I said I've talked to many who have...meaning your peers.

 

[SouthernSurgeon]

Thanks. Maybe that's why I said I've talked to many who have...meaning your peers.

Well I went to a DI school, and talked to a lot of the football players. So that means I know what it's like to play in the NFL...

 

[niranjan162]

Thanks. Maybe that's why I said I've talked to many who have...meaning your peers.

I watched this movie where this guy lands a plane. I'm pretty sure I can do it too now.

 

[scube]

I watched this movie where this guy lands a plane. I'm pretty sure I can do it too now.

THAT is not what was said!!!!!! Have you, however talked to a bunch of pilots? Then you would surely know what it like to land a plane, and if you take some online classes you can be a pilot too.